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• Title
• Copyright Page
• Table of Contents
• Introduction
• About This Book
• Where to Go from Here
• Icons Used in This Book
• How This Book Is Organized
• Part I: Medical Ethics, or Doing the Right Thing
• Part II: A Patient’s Right to Request, Receive, and Refuse Care
• Part III: Ethics at the Beginning and End of Life
• Part IV: Advancing Medical Knowledge with Ethical Clinical Research
• Part V: The Part of Tens
• Foolish Assumptions
• What You’re Not to Read
• Conventions Used in This Book
• Part I: Medical Ethics, or Doing the Right Thing
• Chapter 1: What Are Medical Ethics?
• Defining Medical Ethics
• What are ethics?
• The four principles of medical ethics
• Differences between ethics and legality
• Reconciling medical ethics and patient care
• Turning to ethical guideposts and guidelines
• Looking at the Common Medical Ethics Issues
• Privacy and confidentiality concerns
• Reproduction and beginning-of-life issues
• End-of-life issues
• Access to care
• Moving Medicine Forward: The Ethics of Research
• Chapter 2: Morality in Medicine
• Distinguishing among Ethics, Morality, and Law
• Looking at the Hippocratic Oath and Its Modern Descendents
• Noting why the Oath was updated
• Taking a new oath at graduation
• Understanding humanitarian goals: The Declaration of Geneva
• Rules for Engagement: Today’s Codes of Medical Ethics
• American Medical Association Code of Ethics
• American Nursing Association Code of Ethics
• Bedside Manners: Ethics inside the Hospital
• Understanding the hospital ethics panel
• Patient bill of rights
• Emergency room ethics
• Bioethics as a Field of Study
• Chapter 3: The Provider-Patient Relationship
• Protecting Patient Privacy
• Understanding confidentiality
• Balancing privacy with public good
• Confidentiality in research
• Clear and Ethical Communications
• Communicating with the patient
• Informed consent
• Understanding Full Disclosure: Telling the Patient What Matters
• Decoding conflicts of interest
• Deciding who has access to medical information
• Choosing not to disclose information to a patient
• Understanding Appropriate Referrals
• Considering second opinions
• Discovering the need for specialist referrals
• Choosing Whom to Serve
• Refusing to treat a patient
• Ending a doctor-patient relationship
• Giving medical advice to non-patients
• Patient Rights and Obligations
• Patient autonomy: Patient as decision-maker
• Encouraging honesty
• Balancing treatment and cost
• Chapter 4: Outside the Examining Room: Running an Ethical Practice
• Propriety in the Paperwork: Medical Records
• Complying with the Health Insurance Portability and Accountability Act (HIPAA)
• Training staff to handle records
• Preventing identity theft
• Releasing medical records
• Safeguarding anonymity
• Modern Managed Care and Today’s Office Practice
• Ethical concerns of managed care
• Working with midlevel providers
• Prescribing good care while still getting paid
• Third-Party Issues
• Dealing with insurance companies and HMOs
• Perks and freebies
• Targeted advertising and ethics
• Chapter 5: Learning from Mistakes: Disclosing Medical Errors
• Types of Medical Errors and Ways to Prevent Them
• Understanding diagnostic errors
• Understanding treatment errors
• Medication errors
• Communication errors
• Administrative errors
• Lab errors
• Equipment failures
• Admitting Your Mistakes
• Understanding truth telling
• Disclosing an error to a patient
• Balancing ethics with legal protection
• Telling a higher-up that you’ve made an error
• When Colleagues Don’t Disclose: Your Ethical Obligations
• Healthcare Provider Impairment
• Knowing the warning signs of impairment
• Addressing a colleague’s impairment
• Testifying before a medical board
• How Reporting Errors Helps Medicine as a Whole
• Creating a no-blame system for reporting errors
• Understanding how to reduce errors
• Part II: A Patient’s Right to Request, Receive, and Refuse Care
• Chapter 6: The Ethical Challenges in Distributing Basic Healthcare
• Ethics of Healthcare Distribution
• Exploring Healthcare Rationing
• How services are rationed
• The ethics of rationing
• Looking at Healthcare in the United States
• The current system and its ethical challenges
• The reformed system and potential ethical speed bumps
• Examining universal healthcare
• Chapter 7: When Spirituality and Cultural Beliefs Affect Care
• Accommodating Religious Beliefs
• Religions that limit or ban medical care
• Discussing religion and understanding objections
• Offering alternatives to care
• Respecting Cultural Diversity
• Attitudes and beliefs that affect care
• Communicating with non-English-speaking patients
• Discussing cultural beliefs
• When the Patient Refuses Treatment
• Determining competency
• Making sure the patient understands
• Validating concerns and assuaging fears
• Accepting refusals
• Chapter 8: Parental Guidance and Responsibilities
• Acknowledging Parental Rights to Choose or Refuse Care
• Responsibilities of a parent
• Weighing parental choice against a child’s best interest
• Caring for a child when parents disagree with you
• Knowing when and how to treat impaired infants
• Vaccination: The Evidence and the Ethics
• Understanding vaccination as a public health issue
• Considering risk-benefit analysis
• Understanding full disclosure
• Addressing parent opposition to vaccines
• Child Endangerment: The Healthcare Provider’s Role
• Discovering signs of abuse and neglect
• Reporting abuse and workingwith Child Protective Services
• Confidentiality, Care, and the Adolescent Patient
• Understanding adolescent patients’ rights
• Balancing privacy and patient’s rights
• Talking to teens about informed consent
• Mature minors and emancipated minors
• Part III: Ethics at the Beginning and End of Life
• Chapter 9: Two Lives, One Patient: Pregnancy Rights and Issues
• Medical Intervention: Rights of the Mother versus Rights of the Fetus
• Setting forth rights with the Fourteenth Amendment
• Understanding self-determination
• Balancing treatments for a woman and fetus
• The role of technology
• Considering a Father’s Rights
• Birth Control
• Educating your patient about birth control
• Balancing your beliefs about birthcontrol with a patient’s rights
• Understanding religious ethics and birth control
• Fetal Abuse
• Maternal drug abuse or neglect: Crimes against the fetus
• Detecting fetal abuse: Ethical and legal obligations
• Limiting maternal freedom for fetal well-being
• Seeing into the Future: Prenatal and Genetic Testing
• Understanding the ethical use of prenatal testing
• Understanding tests and accuracy issues
• Genetic counseling and sharing results with parents
• Chapter 10: When Science Supersedes Sex: Reproductive Technology and Surrogacy
• In Vitro Fertilization
• Understanding acceptableversus unacceptable harm
• Pre-implantation genetic diagnosis: Choosing which embryos to implant
• Multiple pregnancy reduction: When IVF works too well
• Decoding embryo storage and destruction
• Artificial Insemination
• Understanding safe, anonymous,and consensual sperm donation
• Sex selection: Is it ever ethical?
• Surrogacy: Carrying Someone Else’s Child
• Paying for pregnancy: The ethics of commercial surrogacy
• Considering the emotional and physical health of the surrogate
• Looking at the contract and surrogate responsibilities
• Understanding rights of the child
• The doctor’s responsibilities
• Sterilization: Preventing Reproduction
• Voluntary sterilization as birth control
• The ethics of involuntary birth control
• Understanding eugenics: Social engineering
• Chapter 11: Walking a Fine Line: Examining the Ethics of Abortion
• When Does Personhood Begin?
• What, and who, is a person?
• Applying ethical principles to personhood
• Looking at Each Side’s Point of View
• Understanding the pro-life stance
• Understanding the pro-choice stance
• Therapeutic Abortion: To Protect Maternal Health and Life
• Reasons for therapeutic abortion
• Informing the patient
• Counseling for the family
• When a patient refuses medical advice
• Abortion Due to Fetal Defect
• Reasons for abortion because of fetal defect
• Weighing the ethics of selective abortion
• Voluntary Abortion
• Legal definition and limitations
• A less invasive option: RU-486
• Roe v Wade: Legal Status of Abortion and Ethical Implications
• Looking at changes on the state level
• Accurate medical counseling
• The Religious Divide
• Toward Common Ground
• Chapter 12: Determining Death: Not an Event, but a Process
• Defining Death
• Using heart and lung function to define death
• Adding brain function to the definition of death
• Examining Brain Death
• A quick look at how the brain works
• Looking at the types of brain death
• Current standards of brain death
• Declaring a patient brain dead
• Understanding Cases That Defined Brain Death
• Karen Ann Quinlan
• Nancy Cruzan
• Withdrawing Life-Sustaining Treatment
• Weighing the benefits of further treatment
• Counseling the family
• Examining Euthanasia and Physician-Assisted Suicide
• Relieving suffering with mercy-killing
• Understanding the history of physician-assisted suicide
• When a doctor aids in death
• Chapter 13: Death with Dignity: The Right to Appropriate End-of-Life Care
• Roadmaps for the End of Life
• Understanding advance directives
• Looking at living wills
• Looking at Durable Power of Attorney for Health Care
• Do Not Resuscitate and Do Not Intubate orders
• Physician’s Order for Life-Sustaining Treatment (POLST)
• Of Sound Mind: Establishing Mental Capacity
• Understanding informed consent and a patient’s ability to give it
• Assessing decision-making capacity
• Substitute decision-makers: When a patient is declared incompetent
• Relief of Pain and Suffering
• Understanding palliative care
• Walking a fine line: The double-effect rule
• Easing pain with terminal sedation
• Organ Donation and Allocation for Transplants
• Legality of organ donation
• Sustaining life for organ harvesting
• Looking at living donation
• The financial inequities of transplant eligibility
• Compensation for donation: The ethical challenges
• Xenotransplantation, or animal to human transplant
• Part IV Advancing MedicalKnowledge withEthical ClinicalResearch
• Chapter 14: Toward Trials without Error: The Evolution of Ethics in Clinical Research
• An Introduction to Medical Research
• Moving from lab experimentsto research on humans
• Understanding the importance ofinformed consent in clinical trials
• Turning Points in MedicalResearch in America
• The Tuskegee Syphilis Study: Theethics of withholding treatment
• The establishment of the Office for HumanResearch Protections and IRBs
• Guiding Principles of Ethical Studies
• The Nuremberg Code: New researchstandards in the wake of World War II
• The Declaration of Helsinki: A globalroadmap for ethical clinical research
• Good Clinical Practice Guidelines:Replacing the Declaration of Helsinki
• The Belmont Report: Best ethicalpractices in U.S. research
• Chapter 15: Beyond Guinea Pigs: Anatomy of an Ethical Clinical Trial
• Elements of a Valid Trial: Leveling the Playing Field Ethically
• Collective clinical equipoise: Asking whether a trial is needed
• Understanding basic trial design
• Choosing ethical controls
• Preventing bias with blind studies and randomization
• Minimizing any risk of harm
• The Institutional Review Board: Ethical Gatekeepers of Clinical Research
• Looking at the role of the IRB
• Evaluating and green-lighting a clinical trial
• Recruiting Study Participants
• Deciding to ask patients to participate
• Laying out all the risks and benefits with informed consent
• Full disclosure: Explaining financial and institutional conflicts of interest
• Ending a Trial Early
• Remembering obligations to patients
• Looking at implications for research
• Publicizing preliminary results
• Chapter 16: Research in Special Populations
• Animal Research
• Understanding why animals are used
• Ethical treatment of research animals
• Psychiatric Research and Consent
• Assessing decision-making ability in psychiatric patients
• Protecting the patient: Risk versus benefit
• Pregnancy and Pediatrics
• Understanding research with pregnant women
• Why risk may outweigh the benefits
• Research on children: Surrogate consent
• Chapter 17: It’s All in the Genes: The Ethics of Stem Cell and Genetic Research
• Understanding Stem Cell Research
• Who will benefit? The case for stem cell research
• The ethical debate over embryonic stem cell lines
• Focusing on adult stem cells
• Genetic Testing: Looking for Problems in DNA
• Knowing what we can and can’t change
• Weighing the risks and benefits
• Offering emotional counseling for patients
• Genome Sequencing: Mapping DNA
• Gene patents: Deciding who owns what
• Looking at ethical problems with patents
• Deciding who can use the human genome
• Gene Therapy: Changing the Code
• Weighing the risks and benefits of gene therapy
• Designer genes: Going beyond therapy
• Cloning: Making Copies
• Cloning as a reproductive option
• Growing tissues with therapeutic cloning
• Part V: The Part of Tens
• Chapter 18: Ten Ethical Issues to Address with Your Patients
• Chapter 19: Ten High-Profile Medical Ethics Cases
• Chapter 20: Almost Ten Ethical Issues for the Future
• Index